Individual provider Active NPI

Jonathan Foster-Moore, FNP-BC

  • Family Nurse Practitioner
  • Roxbury, MA
National Provider Identifier
1790394096
Registry record updated Nov 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2330326 Issued in MA
Practice address
45 Dimock St
Roxbury, MA 02119-1208
Phone
(617) 442-8800
Fax
(617) 541-8472
NPI assigned
Jul 23, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2330326 MA Primary

Addresses

Primary practice location

45 Dimock St
Roxbury, MA 02119-1208

Mailing address

112 Hyde Park Ave Apt 3
Boston, MA 02130-4155
Phone (413) 588-1685

Other identifiers 1

IdentifierTypeStateIssuer
110164952AMedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201020003648 MA Practitioner - Nurse Practitioner 4082034665 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Dimock Community Health Center, Inc.Group PAC ID 7012810492, 43 clinicians

Practice addresses (Care Compare)

45 Dimock St
Roxbury, MA 02119-1208
Phone (617) 442-8800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2330326MAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Dimock Community Health Center, Inc CurrentSince Sep 1, 2020 Accepting new patients
Dimock Community Health Center, Inc CurrentSince Sep 1, 2020 Accepting new patients

Locations

45 Dimock St
Roxbury, MA 02119

55 Dimock St
Roxbury, MA 02119

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1605484800000",
    "number": "1790394096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "112 HYDE PARK AVE APT 3",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021304155",
            "telephone_number": "413-588-1685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 DIMOCK ST",
            "city": "ROXBURY",
            "state": "MA",
            "postal_code": "021191208",
            "telephone_number": "617-442-8800",
            "fax_number": "617-541-8472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOSTER-MOORE",
        "first_name": "JONATHAN",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-23",
        "last_updated": "2020-11-16",
        "certification_date": "2020-11-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MA",
            "license": "2330326",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110164952A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roxbury, MA

Sources for this page

Verify at the official NPI Registry.